Garg Rajat, Mohan Babu P, Krishnamoorthi Rajesh, Rustagi Tarun
Department of Internal Medicine, St. John Hospital and Medical Center, Detroit, MI, USA.
Department of Internal Medicine, University of Alabama, Tuscaloosa, AL, USA.
Indian J Gastroenterol. 2018 Mar;37(2):120-126. doi: 10.1007/s12664-018-0841-1. Epub 2018 Apr 5.
Previous studies have reported that peri-procedural administration of rectal indomethacin reduces the risk of pancreatitis in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Based on these studies, gastrointestinal (GI) societies recommend prophylactic rectal indomethacin for all patients undergoing ERCP. However, recent studies have reported contradictory results. The aim of this study was to perform a systematic review and meta-analysis to estimate the pooled relative risk (RR) of post-ERCP pancreatitis (PEP) in unselected patients who received rectal indomethacin before the ERCP (pre-ERCP) compared to patients who received pre-ERCP rectal placebo.
We conducted a comprehensive search of multiple electronic databases and conference proceedings (from inception through September 1, 2017) to identify randomized control trials (RCTs) investigating the role of pre-ERCP rectal indomethacin in reducing the risk of PEP in unselected patients undergoing ERCP. The databases included Ovid, Medline, In-Process, and Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science. We calculated a pooled estimate of the RR of PEP in patients who received pre-ERCP rectal indomethacin compared to patients who received pre-ERCP rectal placebo. The meta-analysis was performed using the random effects model.
Six RCTs with a total of 2229 patients were included in the final meta-analysis. There were 1143 patients in the rectal indomethacin group and 1086 patients in the rectal placebo group. There were 71 events of PEP in the rectal indomethacin group and 114 events of PEP in the rectal placebo group. Pre-ERCP administration of rectal indomethacin significantly reduced the risk of PEP compared to pre-ERCP rectal placebo (RR 0.60, 95% CI, 0.45-0.80; p<0.0001). There was no heterogeneity between the studies (I = 0).
The results of this meta-analysis support the routine pre-ERCP administration of rectal indomethacin in unselected patients to prevent PEP.
既往研究报道，在内镜逆行胰胆管造影术（ERCP）患者中，围手术期给予直肠吲哚美辛可降低胰腺炎风险。基于这些研究，胃肠（GI）学会建议对所有接受ERCP的患者预防性使用直肠吲哚美辛。然而，近期研究报道了相互矛盾的结果。本研究的目的是进行一项系统评价和荟萃分析，以估计在未选择的患者中，与ERCP前接受直肠安慰剂的患者相比，ERCP前接受直肠吲哚美辛的患者发生ERCP后胰腺炎（PEP）的合并相对风险（RR）。
我们对多个电子数据库和会议论文集进行了全面检索（从数据库建立至2017年9月1日），以识别调查ERCP前直肠吲哚美辛在降低未选择的接受ERCP患者发生PEP风险中作用的随机对照试验（RCT）。这些数据库包括Ovid、Medline、在研及其他未索引引文、Ovid MEDLINE、Ovid EMBASE、Ovid Cochrane对照试验中心注册库、Ovid Cochrane系统评价数据库、Scopus和科学网。我们计算了接受ERCP前直肠吲哚美辛的患者与接受ERCP前直肠安慰剂的患者发生PEP的RR的合并估计值。荟萃分析采用随机效应模型进行。
最终的荟萃分析纳入了6项RCT，共2229例患者。直肠吲哚美辛组有1143例患者，直肠安慰剂组有1086例患者。直肠吲哚美辛组发生71例PEP事件，直肠安慰剂组发生114例PEP事件。与ERCP前直肠安慰剂相比，ERCP前给予直肠吲哚美辛显著降低了PEP风险（RR 0.60，95%CI，0.45 - 至0.80；p<0.0001）。各研究之间无异质性（I² = 0）。
这项荟萃分析的结果支持对未选择的患者在ERCP前常规给予直肠吲哚美辛以预防PEP。
